6/22/2010 @ 10:00AM

How Health Care Can Reduce Crime

Debate over the health care legislation continues to rage, and some state attorneys general opposed to the legislation have initiated lawsuits to challenge the constitutionality of insurance mandates. But these AGs should take a closer look at whether these lawsuits are consistent with their mandate to keep their residents safe from crime.

A provision of the enacted health care legislation requires basic benefit insurance packages to cover substance abuse and mental health treatment, effectively making treatment a standard service. Widespread availability of treatment may not appear groundbreaking, but it could prove to be one of health care reform’s most important features because it will reduce crime while simultaneously saving money.

While there are over 20 million Americans who are considered substance abusers, only 2.3 million of them receive treatment every year. The health care legislation will help close this gap by making substance abuse treatment available and affordable.

That isn’t just good public health policy; it’s effective crime policy. There are over 2 million prisoners in the U.S., approximately a quarter of who were convicted of a drug offense. In addition, of the over 6.5 million adults on probation, parole or supervised release from prison, over a quarter are current illicit drug users.

Making treatment available to prisoners, ex-cons and those in danger of becoming either has been shown to have a marked impact on criminal behavior. Reports from around the country indicate that increased admissions to drug treatment are associated with fewer arrests, reduced incarceration and lower recidivism.

The National Treatment Improvement Evaluation Study, a congressionally mandated five-year study of the impact of drug and alcohol treatment, concluded that treatment programs result in significant reductions in criminal activity. In particular, selling drugs declined by 78%, those who supported themselves through illegal activity 48% and arrests for any crime 64%.

As if lower crime rates aren’t a good enough reason to celebrate, it has been widely accepted that treatment programs are more cost-effective than traditional law enforcement strategies. This is even better news for cash-strapped states and taxpayers.

According to numerous cost-benefit analyses from groups including the National Institute on Drug Abuse, for every dollar spent on addiction treatment programs, there is an average $4 to $7 benefit to society in the form of reduced incarceration rates and associated costs of crime, much of which is a direct savings to taxpayers. Some of the more high-performing outpatient treatment programs have even estimated a 12:1 or 18:1 savings-to-cost ratio.

This is in stark contrast to calculations that one dollar spent on traditional incarceration results in only a 37-cent benefit to society in reduced drug-related crime.

Benefits of treatment are even more pronounced when addiction treatment programs are provided prior to criminal activity or in place of incarceration. One study by the Washington State Institute for Public Policy calculated that drug treatment in the community results in a savings of over $2,000 more per participant in reduced crime costs than comparable treatment in prison.

These savings are made possible in part because of the vast difference between costs of treatment and prison. Incarceration costs average $25,000 per person, per year. This doesn’t even include expenditures for building new prisons to house the ever ballooning prison population. On the other hand, treatment programs cost an average of $1,583 a year, with a high of $8,000 for specialized long-term residential treatment.

Ultimately, expanded treatment availability in insurance plans has a good chance of resulting in potential criminals never entering an already burdened system and a reduction in recidivism for those already convicted who have substance abuse issues.

Thus, health care reform has indirectly delivered a win-win solution to law enforcement and social scientists alike.

Attorneys general should be applauding a program that will help lower crime rates and save money, not suing to stop it.

Rachel E. Barkow is professor of law and faculty director, Center on the Administration of Criminal Law, NYU School of Law. David B. Edwards is attorney-in-residence, Center on the Administration of Criminal Law, NYU School of Law.